title: Transumbilical single-incision laparoscopic hepatectomy using precoagulation and clipless technique in a patient with combined hepatocellular-cholangiocarcinoma: a case report.
abstract: We report our first case of single-incision laparoscopic hepatectomy in a 43-year-old woman with a 30-mm solitary combined hepatocellular-cholangiocarcinoma. A port of single-incision laparoscopic surgery was inserted through the abdominal wall using a 2.5-cm single incision in the umbilical area. To obtain adequate operative view for the tumor in segment 6, a 5-mm flexible endoscope, roticulated instruments, and a miniloop retractor were used. After precoagulation with a 5-mm flexible microwave probe, liver resection was performed using laparoscopic ultrasonic shears, soft-coagulation devices, and a tissue-sealing knife. Subsequently, cholecystectomy was carried out for a gallbladder polyp. The procedure was successfully completed without conversion to conventional laparoscopic technique. The operation time was 180 minutes and operative blood loss was uncountable. Transumbilical single-incision laparoscopic hepatectomy using precoagulation and clipless techniques is feasible and seems to provide better cosmetic appearance in selected cases by qualified endoscopic liver surgeons.
authors.affiliation: *Department of Surgery, Jikei University Kashiwa Hospital, Kashiwashita, Kashiwa City, Chiba †Department of Surgery, Jikei University School of Medicine, Nishishinbashi, Minato-ku, Tokyo, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Toyama
authors.forename: Seiya
authors.initials: S
authors.lastname: Yoshida
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Okui
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitamura
authors.forename: Satoru
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D008028:Light Coagulation / Q000379:methods; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D061646:Operative Time